Epidemiological and Clinical Characteristics of Children and Adolescents with Leprosy Admitted Over 16 Years at a Rural Hospital in Ethiopia: A Retrospective Analysis.

AIM: To analyse differences in children and adolescents aged ≤18 years admitted to the leprosy ward in a rural Ethiopian hospital >16 years. METHODS: We retrospectively collected data from leprosy admission registry books on patients with leprosy who were admitted to a referral hospital from September 2000 to September 2016. RESULTS: There were 2129 admissions for leprosy during the study period: 180 (8.4%) patients were s ≤ 18 years old. Of these, 98 (54.4%) were male and 82 (45.6%) were female. The proportion of new diagnoses in children and adolescents was 31.7%, significantly higher than in adults (11.7%; p < 0.001). There were also significant differences in the prevalence of lepromatous ulcers (46.9 vs. 61.7%), leprosy reaction (29.4 vs. 13.0%) and neuritis (16.9 vs.5.3%) between these age groups. CONCLUSIONS: There were more new diagnoses, leprosy reactions and neuritis, and fewer lepromatous ulcers, in children and adolescents compared with adults, with younger patients being referred more frequently to reference centres.

Leprosy ulcers in a rural hospital of Ethiopia: pattern of aerobic bacterial isolates and drug sensitivities.

BACKGROUND: Plantar ulcers, which commonly occur in leprosy patients, tend to recur increasing physical disability. The aim of this study is to identify both the bacteriological profile of these ulcers and the antibiotic susceptibility of the isolated bacteria. MATERIALS AND METHODS: 68 leprosy patients with chronic ulcers attending the in-patient department of Gambo General Hospital, West Arsi, were included in this study. Proper sample collection, inoculation on culture media, and final identification using biochemical methods were undertaken. RESULTS: 66 patients (97.1%) had a positive culture. A total of 81 microorganisms were isolated. Multiple organisms (two or more) were isolated in 15 (22.7% out of positive culture) patients. The main isolation was Proteus spp (30.9%), followed by Escherichia coli (21.0%), Staphylococcus aureus (18.5%) and Pseudomonas aeruginosa (9.9%). In the total number of the isolated bacteria, the antibiotics with less resistance were gentamicin (18.5%), fosfomycin (22.2%) cefoxitin (24.7%), ceftriaxone (25.9%) ciprofloxacin (25.9%), and amoxicillin-clavulanic acid (28.49%). CONCLUSION: The bacteriological study of plantar ulcers of leprosy patients revealed Enterobacteriaceae and S. aureus as the main pathogens involved in such infections. The results of this study may guide empirical therapy in a rural area hospital where culture and susceptibility testing facilities are scarce.

Gender differential on characteristics and outcome of leprosy patients admitted to a long-term care rural hospital in South-Eastern Ethiopia.

INTRODUCTION: In previous studies, women are less aware of causation and symptoms of leprosy and have less access to health care coverage than men, thus contributing to their delay in seeking for treatment. We assess the gender differences in leprosy cases admitted to a rural referral hospital in Ethiopia for 7 and a half years. METHODS: Retrospective data of the leprosy patients admitted to referral hospital were collected using leprosy admission registry books from September 2002 to January 2010. Variables were entered in an Excel 97 database. RESULTS: During the period of study, 839 patients with leprosy were admitted; 541 (64.5%) were male, and 298 (35.6%) female. Fifteen per cent of female patients, and 7.3% of male patients were paucibacillary leprosy cases while 84.8% of female patients and 92.7% of males were multibacillary leprosy cases (p<0.001). Female leprosy patients were younger than male ones (median: 36 versus 44 years) (p<0.001). In the multivariate analysis, age (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.96-0.98; p<0.001), admission for cardiovascular diseases (OR: 7.6, 95% CI: 1.9-29.3; p=0.004), admission for gastroenteritis (OR: 14.0; 95% CI: 1.7-117; p=0.02), admission from out patients clinic (OR: 2.04; 95% CI: 1.1-4.01; p=0.02), and mortality as final outcome (OR: 3.1, 95% CI: 1.2-8.0; p=0.02) were independently associated with female gender. CONCLUSIONS: Female patients with leprosy admitted to hospital were younger, had a different profile of admission and a higher mortality rate than male ones.

Disability profile in leprosy patients' diagnoses in a rural reference leprosy centre in Ethiopia during 1999-2009.

We assessed the epidemiology of disabilities in leprosy cases treated in a rural hospital over a 10-year period. This is a retrospective data collection using leprosy registers and treatment cards in a rural private mission hospital. Over the 10-year period, 210 patients with leprosy were registered for treatment. One hundred and twenty-eight (61.5%) had disabilities (26.0% grade 1 and 35.6% grade 2): 13.5% ocular disabilities, 44.5% disabilities in hands and 44.7% foot impairment. Patients >19 years had more disabilities (66.7% versus 50.7%) (P = 0.03), especially ocular disabilities (16.7% in >20 versus 6.0% in <20 years) (P = 0.03). This study detected a high prevalence of disabilities.

A clinical study of psoriatic arthropathy.

BACKGROUND: The incidence of uncomplicated psoriasis is 1-3% in the general population. Arthritis is found in increased frequency in psoriatic patients and its incidence is estimated to be 5-7%. AIM: To assess the prevalence of arthritis in psoriatic patients. METHODS: Four hundred and seventy-two psoriatic patients were enrolled in the study out of which 40 patients had (psoriatic) arthropathy (PsA). Severity of psoriasis was assessed by the psoriasis area and severity index (PASI). Routine blood investigations were carried out along with radiological investigations. RESULTS: Forty percent of the 40 PsA patients were in the age group of 51-60 years. Seven patients out of the 40 (17.5%) psoriatic arthropathic (PsA) patients had a family history of psoriasis. Nail involvement was observed in 37 cases (92.5%). Rheumatoid factor was present in five out of the 40 (12.5%) PsA patients. Serum uric acid levels were above normal in eighteen out of the 40 (45%) PsA patients. Asymmetric oligoarthropathy was the most commonly observed feature in 42.5% of the 40 PsA patients. Narrowing of joint spaces and erosions were observed in 62.5% and 45% of the 40 PsA patients. CONCLUSION: There is an association between the duration of skin lesions and duration of arthropathy. Similarly the PASI score is also directly related with arthropathy.

Experiencia de un hospital rural de referencia en la lepra en la provincial de ARSI en Etiopía. Evaluación de los casos de Lepra en Hospital general de Gambo. Etiopía / No disponible

La lepra es un problema de Salud Pública en Etiopía con 0,8 casos por cada 10.000 habitantes. El Hospital General Rural de Gambo es un centro de referencia de la provincia d eArsi (Etiopía) para el tratamiento de la lepra. Durante los 9 años del estudio ingresaron889 pacientes con lepra. La estancia media de los pacientes fue de 84,12 días. Los motivos del ingreso hospitalario fueron: ulceración de las extremidades (52,3%) reacción reversa (20,3%), neuritis (9,1%) eritema nudoso leproso (4,5%), problemas oculares (1,3%) y otros problemas no relacionados con la lepra (13,5%). En los últimos 5 años fueron diagnosticados 98 nuevos casos de lepra. Nueve (99,5%) pacientes eran menores de 15 años. El estudio bacteriológico de piel y mucosa se realizó en 93 (94,8%) caso; de ellos en 55 (56,1%) pacientes la prueba fue positiva. La mayoría de los casos fueron lepra multibacilar (n=84; 85%) y solo 14 (14,3%) lepra paucibacilar. Treinta y siete (37,8%) pacientes no tenían ningún grado de incapacidad, 25 825,5%) tenían una incapacidad grado 1 y 36 (36,7%) una de grado 2. La lepra debe seguir recibiendo esfuerzos para mejorar la atención de los pacientes y disminuir las limitaciones funcionales que causan

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Mycobacterium ulcerans disease (Buruli ulcer) in rural hospital, Southern Benin, 1997-2001.

Data from 1,700 patients living in southern Benin were collected at the Centre Sanitaire et Nutritionnel Gbemoten, Zagnanado, Benin, from 1997 through 2001. In the Zou region in 1999, Buruli ulcer (BU) had a higher detection rate (21.5/100,000) than leprosy (13.4/100,000) and tuberculosis (20.0/100,000). More than 13% of the patients had osteomyelitis. Delay in seeking treatment declined from 4 months in 1989 to 1 month in 2001, and median hospitalization time decreased from 9 months in 1989 to 1 month in 2001. This reduction is attributed, in part, to implementing an international cooperation program, creating a national BU program, and making advances in patient care.

[Leprosy surgery in a bush hospital in Africa: experience in Madagascar]. / La chirurgie de la lèpre dans un hôpital de brousse en Afrique: expérience à Madagascar.

We report our experience of leprosy surgery in terms of feasibility and efficacy in a small hospital of bush in Madagascar during the period of September 1989 to January 1993. Operations of neurolysis, corrections of claw hands by the techniques of Lasso-Zancolli or Van Droogenbroeck, arthrodesis, resections and amputations have been performed. Our results suggest that at least a part of these surgical procedures may be performed by a non specialized medical team, taught on the premises. Thus, the cost of treatment will be low and accessible to more leprosy patients.

Childhood leprosy in a rural hospital.

Sixty six cases of childhood leprosy were studied in detail. They comprised of 7.2% of the Hansen's disease cases and 0.1/1000 of the total hospital out patients. Male: female ratio was 2:1. Four cases (6%) only belonged to the multibacillary group. All the multibacillary patients had a family contact of leprosy. Twelve cases (18.2%) showed nerve involvement and 2 cases (3%) had deformities also. One patient had pure neuritic type of leprosy. Leprosy reactions were not observed in any case. Out of 42 patients adequately followed up after completion of treatment, 3 patients (7.1%) had relapse of the disease.

[Treatment and rehabilitation of disabilities caused by leprosy at a rural hospital (Kapolowé, Zaïre)]. / Traitement et réhabilitation des infirmités dues à la lèpre dans un hôpital rural (Kapolowé, Zaïre).

Since 1985, we contribute to treat and rehabilitate the leprosy infirmities at Kapolowe District Hospital (Shaba, Zaire). The setting up of a permanent autochtonous Department (Tschibangu), has taken the place of the temporary expeditions. A first follow-up refers to 138 patients, on which 259 interventions have been done: 165 refer to foot ulcerations and theirs septic osteoarticular complications, 75 relate to neuritis, 8 only have been restorative interventions. 75% of our patients have had a good social reinsertion. The 25% relapses show the importance of a good limb prosthesis, of sanitary education of the patients and their supervision when they go back to brushwood. In the initial period, it is necessary to start by performing in cleanliness surgery, otherwise bright restorative interventions would be inefficient.